Justin Ponton hit the gas pedal and sped his Dodge Charger up a hill to the parking lot of Hurricane City Park, in rural West Virginia. It was November 2017, and he had just found out that a friend was using drugs. Again. Ponton feared what he’d find when he reached the man.
Ponton, 33, only had a few minutes to get there. He has been through this before. As the owner and operator of a sober-living facility in nearby Huntington, he knows all too well how easy it can be to accidentally overdose and die.
Ponton found his friend sitting in the passenger seat of a parked van — just high, not overdosing. Which was lucky considering Ponton didn’t have any naloxone, the overdose-reversing drug that he often carries with him for occasions like this. Had his pal actually overdosed, Ponton would’ve had to wait for the paramedics to arrive.
America’s heroin and opioid crisis killed more than 60,000 people in 2016, according to estimates from the Centers for Disease Control. That’s twice the number of fatal shootings for the same year. Put another way, drug overdoses today kill more people each year than the HIV epidemic did at its peak in the mid-1990s.
States have scrambled to find ways to get users clean and halt the spread of heroin and, increasingly, the synthetic opioid fentanyl — a drug that can be up to 100 times more powerful than heroin. Prescription painkillers also remain problematic, especially in rural states.
But now another drug is working to reverse those statistics.
Breathing can slow down or stop completely when someone is overdosing. It’s in that moment when naloxone — more formally referred to by its brand name Narcan — binds to opioid receptors in the brain and reverses or blocks the effects of other opioids. The drug works in seconds to restore normal breathing.
Naloxone is relatively inexpensive. But as the demand for it has increased, so too has its price.
“This is absolutely an epidemic,” says Robin Pollini, associate director of the West Virginia University Injury Control Research Center, which studies opioid abuse. Her state has the dubious distinction of having the highest rate of overdose deaths — 52 per 100,000 people, compared to 19.8 per 100,000 people nationwide. “Have we seen the worst of the drug problem? I don’t think any of us can say, because I don’t think we have a real handle on what’s going on out on the street or in people’s homes.”
Opioid abuse crosses state lines, of course, but recent coverage of the epidemic has put a spotlight on West Virginia — and Huntington in particular. In 2016, the city of just 49,000 made national headlines after 26 people overdosed in one five-hour span. The event launched a federal investigation by the CDC and a media firestorm that was quick to label Huntington as “America’s overdose capital.”
As director of outreach of WVU’s Injury Control Research Center, Herb Linn became curious about the effectiveness of take-home naloxone kits. During the heroin scourge of the 1990s, the kits, which typically contain two doses of naloxone, were distributed to drug users in major cities where heroin was prevalent, including New York, Los Angeles and Baltimore. Recipients administered the naloxone themselves when someone nearby overdosed.
Getting an opioid antidote in the hands of drug users in big cities — where you can pinpoint at-risk communities in dense areas and then focus on treatment and prevention — is easier than it would be in the rural environs outside of Huntington. “I became very intrigued about whether this kind of program could translate to a rural population … and whether it would be effective with abusers of opioid pain medicines.”
That’s a legitimate concern, says Pollini, who argues that it’s not enough to simply take a program that worked in a densely populated city and apply it to a remote town of 1,000 people.
“In rural areas, you don’t see [drug users] out in the open as much. There’s not a street scene like you might see in Baltimore or Philly,” she says. “And they’re not accustomed to outreach from harm reduction programs.”
And then there is the stigma of drug dependency, especially in small towns where it can seem like everyone knows your business. For addicts and their families, the fear of public shaming may deter requests for the life-saving kit.
In 2013, Linn published a brief on the effectiveness of naloxone when it’s made widely available in a community. He shared it with public officials in the state, and two years later, the legislature passed a law allowing physicians to prescribe naloxone to anyone who might have to use it — from drug users and their families to first responders answering an emergency call.
“What that did was open up the door to folks who were allowed under that legislation to start programs,” he says. For Linn, that helped local communities start distribution programs from late 2015 through 2016 and led to a collaboration with the state to distribute over 8,250 kits in 2017.
Among those receiving kits were emergency workers in Huntington. They began a pilot program that deploys a quick-response team whenever there’s an overdose. Not only do first responders administer naloxone to revive someone, but they also stay on the case by working to get the victim into a treatment program or a drug court.
Experts say the city has seen a dramatic turnaround in the number of people dying from overdoses.
“We have educated the community about what an overdose looks like,” says Kim Miller, director of corporate development for Prestera, a rehab clinic, and a clinical expert in opioid addiction. “In Huntington, we have allowed access to [naloxone], so that more people are carrying it than ever before. If you’re at a restaurant and someone overdoses in the restroom, for example, and you carrying naloxone, you could save their life.”
That belief has Ponton constantly scrambling to stock up on more of the kits. Currently, he relies on donations to keep a steady supply on hand at his sober-living home.
After the close call with his friend that night in November, Ponton asked the city’s fire chief, Jan Rader, for a kit she had on her.
“I hope we figure out a way to get more of these out there,” he said, before giving her a hug and heading back to his car.
Less than two weeks later, he used that same kit to revive someone else from yet another overdose.
Additional reporting by Kayle Hope.